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. 2024 May 20:33:e28.
doi: 10.1017/S2045796024000295.

The long-term spatio-temporal trends in burden and attributable risk factors of major depressive disorder at global, regional and national levels during 1990-2019: a systematic analysis for GBD 2019

Zhi-Yang Mo  1 , Ze-Zhen Qin  1 , Jun-Jie Ye  1 , Xin-Xuan Hu  1 , Rui Wang  1 , Ya-Ye Zhao  1 , Ping Zheng  1 , Qiao-Shan Lu  1 , Qiao Li  1 , Xian-Yan Tang  1
Affiliations

The long-term spatio-temporal trends in burden and attributable risk factors of major depressive disorder at global, regional and national levels during 1990-2019: a systematic analysis for GBD 2019

Zhi-Yang Mo et al. Epidemiol Psychiatr Sci. .

Abstract

Aims: Caused by multiple risk factors, heavy burden of major depressive disorder (MDD) poses serious challenges to public health worldwide over the past 30 years. Yet the burden and attributable risk factors of MDD were not systematically known. We aimed to reveal the long-term spatio-temporal trends in the burden and attributable risk factors of MDD at global, regional and national levels during 1990-2019.

Methods: We obtained MDD and attributable risk factors data from Global Burden of Disease Study 2019. We used joinpoint regression model to assess the temporal trend in MDD burden, and age-period-cohort model to measure the effects of age, period and birth cohort on MDD incidence rate. We utilized population attributable fractions (PAFs) to estimate the specific proportions of MDD burden attributed to given risk factors.

Results: During 1990-2019, the global number of MDD incident cases, prevalent cases and disability-adjusted life years (DALYs) increased by 59.10%, 59.57% and 58.57%, respectively. Whereas the global age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR) and age-standardized DALYs rate (ASDR) of MDD decreased during 1990-2019. The ASIR, ASPR and ASDR in women were 1.62, 1.62 and 1.60 times as that in men in 2019, respectively. The highest age-specific incidence, prevalence and DALYs rate occurred at the age of 60-64 in women, and at the age of 75-84 in men, but the maximum increasing trends in these age-specific rates occurred at the age of 5-9. Population living during 2000-2004 had higher risk of MDD. MDD burden varied by socio-demographic index (SDI), regions and nations. In 2019, low-SDI region, Central sub-Saharan Africa and Uganda had the highest ASIR, ASPR and ASDR. The global PAFs of intimate partner violence (IPV), childhood sexual abuse (CSA) and bullying victimization (BV) were 8.43%, 5.46% and 4.86% in 2019, respectively.

Conclusions: Over the past 30 years, the global ASIR, ASPR and ASDR of MDD had decreased trends, while the burden of MDD was still serious, and multiple disparities in MDD burden remarkably existed. Women, elderly and populations living during 2000-2004 and in low-SDI regions, had more severe burden of MDD. Children were more susceptible to MDD. Up to 18.75% of global MDD burden would be eliminated through early preventing against IPV, CSA and BV. Tailored strategies-and-measures in different regions and demographic groups based on findings in this studywould be urgently needed to eliminate the impacts of modifiable risk factors on MDD, and then mitigate the burden of MDD.

Keywords: age-period-cohort study; bullying victimization; childhood sexual abuse; global burden of disease; intimate partner violence; joinpoint regression analysis; major depressive disorder; systematic analysis.

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Conflict of interest statement

All authors have no competing interests to declare.

Figures

Figure 1.
Figure 1.
The ASIR of MDD across 204 countries and territories in 1990 (a) and in 2019 (b), the AAPC of ASIR during 1990–2019 (c), and the trend in ASIR during 1990–2019 (d). ASIR, age-standardized incidence rate; MDD, major depressive disorder; AAPC, average annual percentage change.
Figure 2.
Figure 2.
The parameters estimated by age–period–cohort model for the incidence rates of MDD by gender. Net drifts (horizontal lines) and local drifts (curves) (a), longitudinal age curves adjusted for period effects (b), cohort rate ratios relative to the reference cohort of 1955–1959 (c), and period rate ratios relative to the reference period of 2000–2005 (d).
Figure 3.
Figure 3.
The age-specific numbers and DALYs rates of MDD attributed to IPV (a), CSA (c) and BV (e) in 2019. The AAPC of ASDR attributed to IPV (b), CSA (d) and BV (f) by SDI regions and GBD regions during 1990–2019. DALYs, disability-adjusted life years. MDD, major depressive disorder; IPV, intimate partner violence; CSA, childhood sexual abuse; BV, bullying victimization; SDI, socio-demographic index; GBD, Global Burden of Disease Study.
Figure 4.
Figure 4.
The AAPC of ASDR attributed to IPV (a), CSA (b) and BV (c) across 204 countries and territories during 1990–2019. AAPC, average annual percentage change. ASDR, age-standardized DALYs rate. IPV, intimate partner violence. CSA, childhood sexual abuse. BV, bullying victimization. DALYs, disability-adjusted life years.
See this image and copyright information in PMC

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